Spot the tweakment: the new cosmetic surgery

Forget the full-on facelift and other scary procedures. Today, cosmetic enhancement is all about regular fine-tuning.

By Katie Becker

April 28, 2016 — 1.56pm

The days of flaunting obvious work are over. The new wave of subtle cosmetic procedures is quick, high-tech and leaves everyone guessing. More than the movies, the recent awards season in Hollywood was all about playing the game of "Did she or didn't she?" Facelift? Botox? Lipo? Or are Cate Blanchett and Charlize Theron really so genetically blessed while the rest of us helplessly sag, wrinkle and mottle? "Other than the kid who was in Room, everyone's getting something done," says New York dermatologist Dendy Engelman. "But if you can tell there's work, I haven't done my job."

Call them "tweakments". Gone are the days of obvious nose jobs, eyelifts, frozen Botoxed foreheads and chipmunk cheek filler. Instead, new technologies and techniques using injectables and lasers allow doctors to do "tweaks", making cosmetic work harder to spot. These little improvements, many doctors argue, can work to stave off the need for major renovations, such as a face-lift, later on. "People are starting younger and making small, regular adjustments part of their routine," says cosmetic surgeon Paul Frank, also based in New York. "It's like working out or cleaning your apartment; you can't just do it once in spring. A-list patients are often at my office monthly."

With this shift, an elite group of dermatologists and cosmetic surgeons find themselves in demand for their light hands and innovative tricks that leave everyone guessing. The secret is treating unexpected areas. Case in point: Engelman uses filler in the temples to make the face look less hollow, in the lower corners of the jaw to pull up jowls and sharpen the jawline, in the scalp and hairline to even out brows or give a browlift effect, and in only the very upper parts of the cheeks to lessen dark circles under the eyes and the parentheses around the mouth. For the particularly fastidious client – someone who often finds themselves on HD TV, for example – she will perform a 30-minute "airbrushing" to fill in microscopic lines from forehead to chest.

On an even more minute scale, LA dermatologist Annie Chiu shrinks pores using a device called an AquaGold, a tiny canister with 20 24-carat-gold micro-needles, each less than a millimetre long, filled with diluted Botox. By stamping it across the cheeks and forehead, she disperses a superficial amount of the paralysing toxin into the skin, causing pores to relax and reduce. She takes a similar approach to lips, using a tiny needle to inject micro-droplets of hyaluronic acid filler – which is naturally hydrating – across the lips for a dewy, glossy look that lasts two months. And she's always keen to fill in the earlobes; they can suffer the same fate as our faces, becoming lined and droopy. Injecting filler into the ear wrinkles will plump them up and create a smooth backdrop for earrings.

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Tweakments don't stop at the face. "I can instantly make someone look five kilograms lighter just by removing the fat under the arms and in front of the armpit," says Frank, who uses liposuction. Other experts are using the new fat-dissolving injectable Kybella, which is approved for the double chin but, off-label, is especially good at nixing those annoying little pockets that hang over a strapless dress.

Dermatologist Tina Alster, whose office is two blocks from the White House in Washington, probably has the most sensitive group of patients. "We have a lot of male politicians and people from Capitol Hill who come in to get the redness in their cheeks lasered away, so they don't look like they're blushing on TV, or Botox between their eyebrows so they don't look as angry," she says. Alster also uses the toxin in the armpits, scalp and palms of the hands to stop the sweating that occurs under TV lights or while glad-handing at fundraisers.

Part of a good tweakment is also what's left behind. "If I have a patient who wants to chase every little line, I'll work hard to convince them to keep their crow's feet," Engelman says. "It looks nice, like you're really smiling, and makes the rest of the work seem more believable."

Beverly Hills dermatologist Harold Lancer, who claims he had 32 patients on the Oscars red carpet in February, could be considered the tweakment king. Lancer caters to celebs and agents whose greatest fear is that awards broadcasts will cut from the clip of the nominated performance, shot months before, to the nominee in the live audience – and the images won't match up. "If their face looks obviously different between then and now, someone is going to kill me," he says.

A tweakment may sound simple, but it can be complex. Lancer starts his celebs on a strict rejuvenation plan four to six months before a big event. They come in every three to four weeks for a "power buffing", executed using his custom-made exfoliating machine, which suctions in skin while stripping away dead cells, followed by a vegan stem-cell facial and LED light therapy coupled with pure oxygen. While toxins and fillers are staples in his practice, Lancer's latest obsession is NovaThreads – absorbable micro-threads that are injected into the skin in a basket-weave pattern to lift and plump the skin and stimulate the production of collagen and elastin. The effect lasts long after the threads disappear a few months later. For the full-on Lancer treatment, a patient should expect to be in his office twice a month and, he says, shell out $US50,000 a year. Victoria Beckham and Room Oscar-winner Brie Larson follow this non-surgical routine – which includes strict dietary rules and at-home skincare – "to the micro letter", Lancer says.

So what about the rest of us? Lancer says you could see a huge difference by following the right skincare regimen and cutting sugar, caffeine, dairy and salt from your diet. Otherwise, you could book in to see the tweakment king himself. Just be prepared for that bill.

Edited version of a story first published in The Times, UK

FIVE "ADJUSTMENTS" TO TRY

By Stephanie Darling

Facial tweaking Small amounts of a filler, such as Restylane, are injected into the skin to address face "shadowing" (loss of volume), a natural result of ageing. Faces can be instantly refreshed by restoring tone to areas around the eyes and nose, and at the temples, forehead and chin. Sydney: Dr Van Park, drvanpark.com.au. From $600 for a single one-hour session. Melbourne: The Victorian Institute of Cosmetic Medicine, thevictoriancosmeticinstitute.com.au. From $600 for one hour.

Radio waves Ultherapy is a non-invasive procedure using ultrasound energy that heats skin tissue at depths of 3mm-4.5mm to activate the skin's regenerative response. This, in turn, stimulates the growth of new collagen and elastin. It works wonders on the face, neck and jawline, tightening and lifting the skin, and can also create a mini browlift. Sydney: silkwoodmedical.com.au. From $700 for one hour. Melbourne: skintemple.com.au. From $700 for one hour.

Top gun The very latest non-surgical cosmetic procedure comes in the form of a single half-hour treatment using a nine-needle hydro facial "gun" that delivers hyaluronic acid into the dermis for a fast-acting pick-me-up. The hyaluronic acid boosts collagen and, in the process, improves skin elasticity and clarity. Sydney: Dr Joseph Hkeik, www.allsaintscosmedical.com.au. From $440 for 30 minutes. Melbourne: Dr Alicia Teska, skintemple.com.au. From $440 for 30 minutes.

Chin Chiselling This is liposculpture that targets the ageing, sagging neck. A blunt cannula is worked over the area through tiny incisions targeting excess fat deposits with a fluid that contains local anaesthetic and adrenalin. The cannula manipulation and the solution break down the fat, which is then extracted via the cannula. Post-procedure, the chin is more defined and results continue to improve over the next six months. Sydney: Dr Meaghan Heckenberg, besculptured.com.au. $4500. Melbourne: Dr Peter Paraskevas, veinhealth.com.au. $5000.

Lip service Lip treatments have come a long way since the notorious "trout pout". The latest quick fix for deflated lips is dermal filler artfully injected into the lip pads and at the corner of the mouth to address loss of collagen, elastin and hyaluronic acid. Sydney: Face Plus Medispa, faceplus.com.au. From $590 for one 20-minute session. Melbourne: The Skin Institute, theskininstitute.com.au. From $590 for one 20-minute session.